“Is larger always better?” An in vitro comparison of cyclical and static aspiration with different catheters in a neurovascular flow model

BACKGROUND: Recent advances in mechanical thrombectomy for large vessel occlusion suggest that cyclical aspiration (CyA) may enhance clot ingestion and reduce embolic complications compared with static aspiration (StA). We aimed to identify the experimental conditions under which CyA outperforms StA. METHODS: A 3D-printed neurovascular model in a flow loop (137/89 mmHg, 72 bpm) simulated middle cerebral artery M1 segment (MCA-M1) occlusions with soft and stiff clot analogs. CyA (4.5 Hz and Δp=85-105 kPa) was performed with a dual-solenoid device coupled to a vacuum pump. Eighty experiments were randomized into four treatment arms combining aspiration patterns and 0.071″ and 0.088″ aspiration catheters: CyA-71, CyA-88, StA-71, and StA-88. RESULTS: The overall first pass recanalization (FPR) rate was 74% (59/80), with CyA significantly outperforming StA (92% vs 55%, p